Provider Demographics
NPI:1447521273
Name:BURGESS, BONNY A (RN)
Entity type:Individual
Prefix:
First Name:BONNY
Middle Name:A
Last Name:BURGESS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1892 SHARRICK RD
Mailing Address - Street 2:
Mailing Address - City:DARIEN CENTER
Mailing Address - State:NY
Mailing Address - Zip Code:14040-9718
Mailing Address - Country:US
Mailing Address - Phone:585-547-9271
Mailing Address - Fax:
Practice Address - Street 1:3314 BUFFALO ST
Practice Address - Street 2:
Practice Address - City:ALEXANDER
Practice Address - State:NY
Practice Address - Zip Code:14005-9701
Practice Address - Country:US
Practice Address - Phone:585-591-1551
Practice Address - Fax:585-591-4713
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-25
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY423595163W00000X, 163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
No163W00000XNursing Service ProvidersRegistered Nurse